What are the chiropractic CPT codes?

Chiropractors report spinal manipulation with chiropractic manipulative treatment (CMT) codes 98940, 98941, and 98942, which step up with the number of spinal regions treated, plus 98943 for extraspinal regions. A visit can also carry an evaluation and management (E/M) code with modifier 25 and therapy codes such as 97110, 97112, 97140, and 97012 when the payer covers them. Medicare covers only manual manipulation of the spine to correct a subluxation, and it requires the AT modifier on 98940 through 98942 when the treatment is active or corrective.

Sources: Medicare Benefit Policy Manual, chapter 15, section 240 (CMS, primary), Chiropractic Services article A57889 (CMS Medicare Coverage Database), and the UnitedHealthcare Medicare Advantage chiropractic quick reference (payer, primary).

CPT is a registered trademark of the American Medical Association, which owns and maintains the code set. The descriptions below are plain-English summaries written for orientation. Bill from the current official descriptors. For the structure of the code set itself, see a wellness pro's guide to CPT codes.

Which CMT code matches the number of spinal regions you treated?

98940 covers one or two spinal regions, 98941 covers three or four, and 98942 covers all five. Medicare recognizes five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic. Manipulation of the extraspinal regions, which cover the head, the upper and lower extremities, the rib cage, and the abdomen, is reported with 98943.

The region counts come from the UnitedHealthcare quick reference. The five spinal regions, the extraspinal list, and the 98943 exclusion come from CMS article A57889. The CMS regions include specific joints: the atlanto-occipital joint sits in the cervical region, the costovertebral and costotransverse joints in the thoracic region, and the sacro-iliac joint in the pelvic region.

Your note has to name each region you treated and the precise level of the subluxation in it. CMS states that the precise level must be specified to substantiate a claim for manipulation of each region, and that a diagnosis of pain by itself is insufficient.

What are Medicare-covered chiropractic services?

Medicare covers manual manipulation of the spine to correct a subluxation, and no other service a chiropractor furnishes or orders. The patient needs a significant neuromusculoskeletal condition, a subluxation shown by X-ray or physical exam, and active or corrective treatment, which you flag with the AT modifier. Once the condition is stable and no further objective improvement is expected, the care counts as maintenance therapy and Medicare does not pay for it.

The CMS Medicare Benefit Policy Manual sets the working rules:

• Manual manipulation only. Coverage is limited to treatment by hand, and a hand-held manual device is allowed with no added payment for the device.
• X-rays and other tests. If you order, take, or interpret an X-ray or other diagnostic test, Medicare coverage and payment are unavailable for it. An X-ray is optional for showing subluxation.
• Physical exam route. To show a subluxation by exam, you document two of four findings: pain or tenderness, asymmetry or misalignment, a range-of-motion abnormality, and tissue or tone changes. One of the two has to be asymmetry or misalignment, or a range-of-motion abnormality.
• Diagnosis. The primary diagnosis is the subluxation, with its level. The CMS Medicare Coverage Database billing guidelines (L34585) list the neuromusculoskeletal condition as the secondary diagnosis.
• One treatment a day. Reimbursement is limited to one treatment per day.

CMS reports a 33.6% improper payment rate for chiropractic services in its 2024 reporting period, and insufficient documentation accounted for 95.5% of those improper payments. Source: CMS Medicare Learning Network, Chiropractic Services. Initial-visit notes need the history, the present illness, the exam, the diagnosis, a treatment plan with duration and frequency, and the date of the first treatment. Subsequent-visit notes need the chief-complaint review, the change since the last visit, the exam of the involved spinal area, and the treatment given that day.

Sources: Medicare Benefit Policy Manual, chapter 15, sections 240.1.1 to 240.1.5 (CMS, primary) and Billing and Coding Guidelines for Chiropractic Services, L34585 (CMS Medicare Coverage Database, last revised 2018).

What do the AT, GA, GZ, GP, and 59 modifiers mean on a chiropractic claim?

AT marks active or corrective treatment on a Medicare CMT claim. GA marks a claim where you gave the patient an Advance Beneficiary Notice (ABN), and CMS names GZ as an alternative to GA in rare instances. GP is the therapy modifier for services delivered under an outpatient physical therapy plan of care, and 59 (or XS) separates a therapy service in a different region from the one you manipulated.

GP appears in the CMS manual as the therapy modifier for services under an outpatient physical therapy plan of care. A commercial payer that wants GP on chiropractic therapy codes states that in its own policy, so confirm it per payer before you add it.

Sources: Medicare Benefit Policy Manual, section 240.1.3, Medicare Claims Processing Manual, chapter 5, and Medicare NCCI Policy Manual, chapter 11 (all CMS, primary).

Can you bill an E/M visit with modifier 25 on the same day as a CMT?

Yes, when the E/M service is significant, separately identifiable, and unrelated to the decision to perform the manipulation. CMS classifies CMT with a zero-day global period, so a routine pre-manipulation check belongs to the CMT and modifier 25 goes on the E/M code for work beyond it. Medicare's own chiropractic benefit excludes office visits, so this route applies to payers whose policies pay for chiropractic E/M.

The CMS NCCI Policy Manual states that chiropractic manipulative treatment has a global period of 000 days, which makes it a minor surgical procedure. It states that E/M services on the same date are included in the payment for the procedure, and that a significant and separately identifiable E/M service unrelated to the decision to perform the procedure is separately reportable with modifier 25. The E/M and the procedure do not need different diagnoses.

Three working rules follow from the CMS text:

1. Append modifier 25 to the E/M code only. The Medicare Claims Processing Manual, chapter 12, section 30.6.6, restricts it to E/M services.
2. Document the E/M service and the CMT each in full. The same manual requires both to be sufficiently documented in the record.
3. Check the payer's chiropractic E/M policy. An AAPC analysis of same-day CMT and E/M reporting points readers to the NCCI manual when a payer gives little guidance, and notes that the references can differ by payer.

Sources: Medicare NCCI Policy Manual, chapter 11 (CMS, revision date 1/1/2024), Medicare Claims Processing Manual, chapter 12 (CMS), Understand the Complexity of Reporting Same Day CMT and E/M Services (AAPC, October 2018), and L34585 for the Medicare office-visit exclusion.

Is 97012 a chiropractic code?

97012 is the CPT code for mechanical traction. A chiropractor can report it to a payer whose policy covers traction. Medicare's chiropractic billing guidance lists traction among the services it excludes when a chiropractor performs them.

CMS describes 97012 under its outpatient therapy billing article with the label "Traction, Mechanical." That article applies to Medicare physical and occupational therapy services. Use it to identify the code. For a chiropractic claim, the payer's own policy sets coverage.

Sources: Billing and Coding: Outpatient Physical and Occupational Therapy Services, A56566 (CMS Medicare Coverage Database) and L34585 (CMS).

Which therapy codes do chiropractors add to a CMT visit?

Therapy codes you can add to a CMT visit, where the payer covers them, include 97110 therapeutic exercise, 97112 neuromuscular re-education, 97140 manual therapy, 97012 mechanical traction, and unattended electrical stimulation. For electrical stimulation, CMS states that CPT 97014 is not a Medicare recognized code and points to HCPCS G0283 instead. Medicare's NCCI manual does not allow 97112 or 97140 in a spinal region you manipulated, and modifier 59 or XS applies only when the therapy service is in a different region.

For 15-minute timed codes, the CMS counting rule in its outpatient therapy chapter bills one unit for 8 through 22 minutes of a single code in a day, two units for 23 through 37 minutes, and three units for 38 through 52 minutes. A commercial payer sets its own unit rules, so confirm them before you bill two timed codes in one visit.

The Medicare chiropractic benefit covers none of these therapy codes when a chiropractor furnishes them, per the Benefit Policy Manual. Chiropractic offices can submit the charges to Medicare to obtain a denial for a secondary carrier, according to the L34585 guidelines.

Sources: Medicare NCCI Policy Manual, chapter 11, Billing and Coding article A56566, Medicare Claims Processing Manual, chapter 5, section 20.2 (all CMS), and the UnitedHealthcare quick reference.

How do you keep chiropractic claims clean?

Match the code to what your note documents, then check the modifier against the payer's policy. The claim file has to support the code you picked, and the Medicare documentation list above shows what a CMS reviewer looks for.

Practice Better's billing and insurance tools let you check eligibility, submit claims, track status, and manage rejections from inside your EHR (US customers), and export format-ready CMS-1500 claims. See how Practice Better works for chiropractors. If you also bill massage therapy services, the massage therapy CPT codes reference explains where 97124 and 97140 differ.

Start a free trial of Practice Better to keep notes and claims in one place.

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Key takeaways

• 98940, 98941, and 98942 report spinal manipulation of one to two, three to four, and five regions. Medicare recognizes five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic. 98943 covers extraspinal regions and sits outside Medicare coverage.
• Medicare covers manual manipulation of the spine to correct a subluxation and no other service a chiropractor furnishes or orders. Active or corrective treatment carries the AT modifier, and a claim without AT is treated as maintenance therapy and denied.
• CMS reports that insufficient documentation accounted for 95.5% of improper payments on chiropractic services in its 2024 reporting period.
• CMT has a global period of 000 days. A significant, separately identifiable E/M service on the same day takes modifier 25 on the E/M code.
• CMS states that 97014 is not a Medicare recognized code and points to G0283. NCCI bundles 97112 and 97140 into a region you manipulated, and modifier 59 or XS applies only when the therapy is in a different region.

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